The Writer and Modern Psychiatry

In an earlier post I discussed how the mental health profession has relied heavily on film for teaching examples and the reasons why.  Today I will discuss how the screenwriter draws on (and perhaps should) modern psychiatry, if not for inspiration, at least for authenticity.  For much of the previous century, films incorporated very little insight from psychiatry.  There were two reasons for this: the first was the fact that psychiatry was still in its infancy; the second was  that most writers had very little contact with the mentally ill.  People that were seriously mentally ill, such as schizophrenics, were almost always placed in mental institutions and thus the public had essentially no contact with them.  There was one exception to this, and that was the psychoanalytic theories and techniques of Sigmund Freud.

The influence of Freud was pervasive in 20th century films, particularly in the area of symbolism. In my Screenplay as Literature I wrote about Federico Fellini’s use of Freud’s theories in his films, particularly in his marvelous 8 ½ (1963).  But despite Freud’s popularity with certain filmmakers, audiences and critics could ignore Freud and still enjoy their films.  For example, with 8 1/2 you could know nothing about Freud or understand little about the inner psychological conflicts of the main character, Guido, yet find the film highly entertaining.

In the last quarter of the 20th Century, psychiatry and mental health practices in general changed dramatically in the United States.  In short, the mental institutions were emptied out, as their former patients were dumped on the public on the justification that powerful new drugs could control their serious mental illnesses.  Thus, for the first time, the public was introduced to people suffering from mental illnesses such as schizophrenia and bi-polar disorder (i.e. manic-depressive).  Then there were the classification of many new syndromes that impair behavior such as attention-deficit and post-traumatic stress syndromes.  Anyone who has watched the television series Law and Order is probably aware of the difficulty that prosecutors have in securing convictions against felons, particularly in the case of murder, due to the proliferation of evermore “syndromes” that can be offered up as a defense

These advances have provided writers with much new material, plot and character wise.  The cable television series Homeland is an intriguing example of this.  In this series the main character, a high-ranking officer for an American spy agency, suffers from bi-polar disorder, for which she takes powerful medications.  It is indeed a breakthrough to depict people with mental illness able to excel in high-powered jobs.  What is fascinating about this series from a writing point of view is that we are never sure when the main character becomes infatuated with a new man if this is a symptom of her bi-polar disorder or actual love.  The same could be said when she becomes stubbornly insistent on her work-related insights—is this genius, or the failure of her medications to work properly?  In any event I am sure that qualified psychiatrists are employed to act as consultants to the show.

The real challenge today may not be serious mental impairments such as schizophrenia, for which people may be institutionalized, but impairments that are referred to as personality disorders. The better known (to the public) of such disorders are paranoid, obsessive-compulsive, narcissistic, and anti-social.  The latter is particularly important for writers of crime shows because it is estimated that up to thirty percent of imprisoned criminals are diagnosed as having anti-social personality disorder (by the way, people who are diagnosed with this disorder are alternately called sociopaths and psychopaths).

Why are personality disorders a challenge for the writer?  They are because most of the characters that writers write about, particularly the most interesting, may be covered by such diagnoses.  Why is this a problem?  It is a problem because it difficult to incorporate the concept of free will.  People diagnosed with a personality disorder may not be capable of making valid choices, such as between good and bad and rational and irrational.   So the problem for the writer when dealing with characters that appear to have one of these disorders is the following:  when trying to determine what the character is going to do next, do you consult a book on dramaturgy and plotting or a psychiatric manual?

A recent cable television series provides an interesting example of a dilemma such as this.  Here, during the first two seasons, one of the main characters does the following:  is unfaithful to her husband, destroys the marriage and family of her lover without remorse, steals drugs from a hospital for her own personal use, willingly participates in illicit drug dealing, lies to her lover (now her second husband) about who got her pregnant, and finally is perfectly comfortable in having him go to prison for a crime that she committed.  You wouldn’t be overreaching if you concluded that this character exhibits many of the characteristics of a psychopath. Keep in mind that she is very sympathetically portrayed (her first child died due to a tragic accident).  And I neglected to mention that her lover/new husband is a classic narcissist.  The question we have to ask ourselves is the following:  is this a story about a woman who desperately wants to get her chaotic life in order or the unfolding of a horrendous train wreck or both?

As a disclaimer I wish to make it clear that I do not purport to be an expert on mental health issues.  My intent is simply to highlight the challenges that these issues present for writers today.  No matter what your opinion is about modern psychiatry, the examples of its relevancy and practice confront us on a daily basis and can no longer be hidden-away behind the locked gates of mental institutions.